Comparison between the different methods developed for determining the onset of the LH surge in urine during the human menstrual cycle

Abstract

Purpose To determine whether an optimal method exists for the detection of the luteinising hormone (LH) surge onset in research datasets of urinary hormonal profiles of menstrual cycles. Methods The scientific literature was searched to compare published methodologies for detection of the LH surge onset in urine. Their performance was tested using complete hormonal profiles from 254 ovulatory cycles from 227 women attempting pregnancy (normal regular menstrual cycles; no known infertility). Results Three major methodologies to determine the onset of the LH surge in urine were identified. The key difference between these methods is how the cycle days that contribute to LH baseline assessment are determined: using fixed days (method #1), based on peak LH day (method #2), based on a provisional estimate of the LH surge (method #3). Method #1 requires no prior cycle information, whereas methods #2 and #3 need to consider complete cycle data. The most reliable method for calculation of baseline LH was using 2 days before the estimated surge day, plus the previous 4/5 days. Conclusions Different methods for identification of the urinary LH surge can provide very different determinations of LH surge day, thus care must be taken when comparing between studies that apply different methodologies. The optimal method for determining the onset of the LH surge in urine requires retrospective estimation of day of LH surge to identify the most appropriate part of the cycle to consider as the baseline. This method can be adopted for application in population studies.

Increased Likelihood of Pregnancy Using an App-Connected Ovulation Test System: A Randomized Controlled Trial

“…[11][12][13] Ovulation typically occurs *24 hours after the onset of the LH surge and will not occur in its absence. 12,14,15 Estradiol is another key hormone that can be used to assess relative fertility. Levels of a principal urinary estradiol metabolite, estrone-3-glucuronide (E3G), have been observed to rise substantially *3 days before ovulation until about 5 days postovulation, which can make it an excellent predictor of the onset of the full fertile window.…”

Do women expose themselves to more health-related risks in certain phases of the menstrual cycle? A meta-analytic review

“…The study must be able to determine the fertile window of the participants (including the few days leading up to ovulation and the day of ovulation itself -see below for further details on how fertility is defined in analyses) or follicular (early or late) or luteal (early or late) or menses. This could be achieved using methods that aim to pinpoint the day of ovulation, such as measures of urinary LH, basal body temperature, or salivary progesterone and estradiol (Godbert, Miro, Shreeves, Gnoth & Johnson 2015), or by using counting methods that estimate current cycle position based on last/next menstrual onset and average cycle length. This criterion was essential to be able to sort the studies according to the different measurement methods (see Table 1-4 in Appendices for menstrual cycle days included in the different studies).…”

Can apps and calendar methods predict ovulation with accuracy?

“…The demographic of women seeking to conceive has changed greatly over the past few decades, with women in more developed countries increasingly delaying pregnancy. Busier lifestyle commitments often coincide with less frequent sexual intercourse so timed intercourse is often used to assist with conception 1,2 . Women planning pregnancy expect to conceive quickly, "within 3-6 months" 3 , leading to anxiety if they fail to do so 4 .…”

“…Therefore, beta LH assays can often provide profiles with more than one surge and have peak levels occurring at a considerable time after ovulation [14][15][16][17][18] . As peak levels can occur post ovulation, even with an intact LH assay, it is more appropriate to measure the LH surge: there are a wide variety of methods for determining the surge 19 , with the most accurate method providing 1-day prediction of ovulation with maximal error of ±1 day 14,15 .…”

“…There is a growing number of fertility applications (apps), although few of them disclose the algorithms that they use 2,20 . Most predictions of the fertile window given by fertility apps are generated from user data, such as date of last menstrual period and cycle length 21 , or the assumption of a 28-day cycle, with ovulation on day 14 22 .…”